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From Chicago, Illinois, USA:

My 6 year old son is a relatively skinny child and had an initial blood sugar level of 1200 with no ketones. No one at the hospital could explain why. Can you tell me why some elevated blood sugar levels cause ketones while others don't? I also talked to a nurse in the hospital who said she has seen levels as high as 4000 with no ketones?


Ketones are produced when the body breaks down fat for energy because the cells in the body are not getting enough calories (either due to inadequate intake of calories, or inability to use ingested calories due to insulin deficiency). In early diabetes, the body may be making enough insulin so the cells aren't "starving," so no ketones are produced, but not enough insulin to keep the blood sugar normal. In my experience, it would be most unusual for a 6 year old with new onset diabetes and a blood sugar of 1200 not to be producing ketones in the urine. Most likely, I would suspect the urine strips for ketones were spoiled.

In adults with non-insulin dependent diabetes, you can occasionally see very high blood sugars without ketones if they also have some kidney impairment interfering with the ability to clear glucose from the body through the urine, especially if they are also dehydrated. [This situation is called non-ketotic, hyperglycemic, hyperosmolar syndrome. Editor]

I have never seen a blood sugar up to 4000.


Original posting 22 Mar 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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